PRINTThe HPV effect
At least half of all sexually active people will contract a genital HPV infection in their lifetime. How does this affect you?
KRISTIN KELLOGG
Click here for information on the prevalence of STDs.
April 26, 2007 | 12:00 a.m. CST
The human papillomavirus, HPV, is the most common sexually transmitted disease among women. The severity of the disease is not only its astounding prevalence among women, but it is also the No. 1 cause of cervical cancer. Only 10 months ago, the first vaccine, Gardasil, was released to the public and continues to stir up political, religious and cultural debates. Many states are trying to mandate the vaccine for girls going into the sixth grade. Preteen sex lives, or lack thereof, are up for review by politicians across the country. Mandating a vaccine for young girls who might not have even had the sex talk has raised many questions. Most insurance companies don’t cover this expensive vaccine, and there is still no vaccine for men and older women. The treatment of HPV is going from clinical to personal.
Guarding against HPV
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Studies for Gardasil, which is currently the only vaccination to protect against HPV, started about 10 years ago, says Jennifer Allen, a spokesperson for Merck, the company that provides Gardasil. The vaccine contains virus-like particles that closely simulate HPV. Like other vaccines, it stimulates the immune system.
In the 10 years of studies, scientists tested more than 25,000 women. In 2001, the vaccine was in its phase three trials, Allen says. However, the Centers for Disease Control and Prevention states that because the vaccine is so new, much of the information is still forming. Because of Gardasil’s recent creation, Merck is only certain that the vaccination is effective for five years. Allen says Merck is still tracking those in its 2001 study, and as research continues, this information will be available and valuable to state policymakers and parents who are still wary of its effectiveness. If proven effective for only five years so far, then is it too much for one man to argue that this vaccine should be mandatory for young girls in the sixth grade?
The state of things
Many government officials have daughters of their own and are concerned with young women’s sexual health. Perhaps that was Texas Gov. Rick Perry’s motive. Perry, a Republican with one daughter, was the first state official to order that sixth-grade girls be vaccinated, yet his proposal was quickly shot down in February. Those against Perry’s bill fear that Gardasil is too unfamiliar and question the role it will play in a young girl’s motive for sexual activity. These opponents also believe receiving the vaccine could lead to premarital sex. Virginia was the first state to mandate a vaccine to prevent cervical cancer, and other state legislatures are proposing that girls entering middle school be vaccinated.
Organizations such as Planned Parenthood support mandating the HPV vaccine in Missouri, but many who are opposed feel that having their daughter vaccinated is a family decision.
HPV is an STD. Why mandate a vaccine that prevents a sexually transmitted disease that will not be caught while sitting in a classroom such as a common cold would? A spokesperson was not available for comment, but Concerned Women for America, a public policy organization founded on biblical principles, claims on its Web site that it is opposed mandating an HPV vaccine for young girls but does not oppose the actual vaccine because it prevents some strands of cervical cancer.
Much like Perry’s attempt was halted in Texas, bills across the U.S. have faced similar problems.
Shots might be shot down
You might think a shot to prevent cervical cancer would have people lining up outside of doctors’ offices. However, it is not that simple.
With any bill, controversy is inevitable. But Missouri Bill No. 802, introduced by Rep. Sam Page, D-Creve Coeur, has had little opposition — even though it involves preteens and conjures up the specter of sexual activity for some.
“I think that people were afraid that there was going to be a lot of controversy, and surprisingly enough there hasn’t been,” says Michelle Trupiano, a lobbyist for Planned Parenthood Affiliates in Missouri. “The controversy lies not in the vaccine but in the mandating of the vaccination.”
An underlying controversy is who gets the tab for the vaccine. If bills mandating the vaccine are passed, insurance companies will be the ones responsible for covering the cost of Gardasil, which might result in increased premiums. For the uninsured, the state would be responsible for covering the vaccine. But if legislators don’t pass the bill and insurance companies do not to pay for the vaccine, those providers would continue to be faced with higher expenses if their clients have abnormal pap smears or are diagnosed with cervical cancer in the future. Because Gardasil is a preventative measure, it could save insurance companies more money over time.
“If we have a chance to prevent most types of cervical cancer, we should invest in the vaccine now,” says Page. As an anesthesiologist, Page has treated many women who suffer from cervical cancer and explains that the pain associated with this cancer is extremely difficult to alleviate.
In February, when Page introduced Missouri Bill No. 802, he proposed that the vaccine be mandated (with a provision for opting out), which is a way of making sure everyone would have paid access. Because the bill got caught up in the mandated-vaccine controversy, the bill was amended earlier in April to be an inform-and-provide measure. This amended version of the bill means parents will be informed about the vaccine, and kids will have paid access. If insurance companies refuse to pay for the vaccine, the state will cover it. Page says this kind of bill is the first step toward making insurance companies cover the vaccine (without it being mandated).
The feeling of uncertainty felt by parents with regard to the vaccine could be settled by government providing more information. Educating parents and making sure they have the correct information will limit confusion that’s important when talking about female sixth graders, says Trupiano.
Some parents have difficulty conceptualizing the timing in their daughters’ lives to get the vaccine, but recommendations from the Food and Drug Administration suggest that females entering sixth grade are at the earliest age to start the prevention of cervical cancer by administering the HPV vaccine. “Parents may feel that although their daughter is 12 or 13 and not sexually active that they don’t need to worry about HPV,” Trupiano says. “Your daughter is going to be sexually active at some point in her life even if she waits until marriage. The HPV vaccine will be a protection measure for her entire life.”
Ruth Morgan, a nurse at MU’s Student Health Center, says it is best if the vaccine is given before the woman is sexually active. Girls and women who have not been infected with any of those four main HPV types will get the full benefits of the vaccine.
The idea Merck proposes — that girls as young as 9 years old should get the vaccine — is causing increasing controversy. Gardasil is recommended by Merck for females ages 9 to 26, but local governments and interest groups would like to mandate the vaccine for girls entering the sixth grade — 12 or 13 years old.
“Not at age 9,” Bonnie Cassida says. Cassida, the mother of 7-year-old Sophia, believes that 9 is too young for girls to receive the vaccine. Cassida says she used to work in sex education at a psychiatric hospital. There she worked with young women who were victims of sexual abuse, so she is aware of the need for Gardasil.
“I’m very excited about this,” she says. However, she would like to wait until the vaccine is on the market for a while before she sends Sophia in to get it. Cassida believes that the decision to get this vaccine is one each parent should make individually.
Continuing to educate the public is a top priority. Although some controversy has revolved around the possibility of administering the vaccine and the potential rise in promiscuity, overall parents are more concerned about the health of their children than the mandating of a vaccine.
“HPV is a public health issue, and this is about keeping females safe and healthy throughout their entire life,” Trupiano says.
Who will pay?
How much would you pay to prevent cervical cancer? One of the primary concerns involving the vaccine is its cost. The vaccine is offered in three separate doses. MU’s Student Health Center charges $153 per dose; Stephens College is a bit cheaper and charges $150 per dose. Planned Parenthood in Columbia is the most expensive, charging $190 per dose, but they offer need-based assistance in the form of a grant, as does the Columbia/Boone County Health Department.
However, you don’t need to have the entire three-dose payment upfront. Many places allow you to pay for each shot individually. The vaccine is given through a series of three shots over a six-month period.
The second dose is given two months after the first dose, and the third shot should be given six months after the first dose. The vaccine retails for $120 a shot. With doctor and pharmacy markups, the price can be up to $500 to $700.
What about men and older women?
Currently, a vaccination for boys and men is being developed. Research for women age 26 and older is also in the works. Because women ages 9 to 26 were the primary group affected by HPV, Merck chose to target this group in its research. Now that the vaccine is released, Merck is continuing research on Gardasil’s effectiveness on males ages 16 to 25 and females ages 27 to 45, Allen says.
Sandra Bachrach, the mother of a 7-year-old boy, says that if the vaccine were offered to boys and young men, she would get it for her son after she researched it.
But, until time passes and further testing occurs, that won’t be possible for Bachrach. Until then, the HPV vaccine might be the conversation starter for future sex talks.
Some extra info ...
About 20 million Americans are infected with HPV. Most cases go away on their own, and many people don’t even know they’re infected. But HPV can lead to genital warts or even cancer.
INFOGRAPHICS SOURCES: National Conference of State Legislatures; CDC
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